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Home My WebLink AboutPermit Electrical 2006-10-10 ZON LIfY? INITlALS kJ iV\ DATE \u-I~-2a)1O SOURCE~I ~ IO-(U-Oro 225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH (541)726-3753 . FAX (541)726-3689 ELECTRICAL PERMIT APPLICATION Clly Job Number Co IN\. z.C,) <:> b - 0 I Z '7 '- Date 1 LOCATION OF INSTALLATION: 277-~ Cel'/rl?"r"rJ'~L- ;J.(.IJO LEGAL DESCRIPTION 17D3 Z '5~L( Dl70C JOB DESCRIPTION C;-IAf'/(,G /()O/JI'1!' "'/"0 2m S(?71/VICl 3 COMPLETE FEE SCHEDULE BELOW A New ResldentIaI- Smgle or MultI-Famd} per dwelImg umt ServIce Included 1000 sq ft or less Each addltlonal 500 sq ft or portlOn thereof $10600 $ 1900 PermIts are non-transferable and expIre If work IS Each Manufact'd Home or not started wlthm 180 days of ISsuance or If work IS Modular Dwellmg ServIce or $5000 Suspended for 180 days Feeder es 'IOU lv . -E I tlJl'4 Vi"IlUH-13W requIT 1rl1~llV 2 CONTRACTOR INSTALLATION ONLF-l I i'l B ~lJi:YtlW~'1 ijeEtl~ tlildr\'r AlteratIOns or Relocahon folloW rule6 a Those rules are set 0 Electncal Contractor NotificatIOn ~~q;q~1J9h OAR 952-00~/ $ 63 00 b '"J In Of'M 952Jg~ OOw1\rtPt:ltlPU\1m~ the rule,,_) $ 75 00 Address 0090 You 40d~ ~A\t1pl;telephon~ $12500 calling the 1111htv Notlflcatl:;r. mberf&QMRi.\f~Iil{Jtl}\:lf,,1)144) $16300 CIty Phone nu C&,t!lf 1~(jI100h\5~It'i". $37500 Reconnect Only $ 50 00 InstallatIOn, AlteratIon or Relocahon NOi ICE 200 Amps or less 20 I Amps to 400 Amps HitS PERMIT4~t1A!n\>sE\~~b\llAJlipIHE WORK AUTHORIZEOcYv~PJOB )];\b~ ~rG~MlvJ!is~Jn'B" above COMMENCl)D {jfiJRc~~lriQNED FOR ANY 180 DAY PERIOD New AlteratIOn or ExtenSIOn Per Panel One CrrcUlt Each AddlllOnal Crrcmt or WIth Service or Feedel Penmt SupervISor LIcense Number _,?{\- r- ExpiratIOn Date OJ Constr Contr Number Exprratlon Date Signature of SupervlSmg Electnclan Owners Name J..AC~ AwOB'/l&JvJ Address cr (q; .\ i-I ~vJ m() f \ CIty E"v6"7v11 c,. Phone "I ~t.( - 6M ) OWNER INSTALLATION The mstallatlOn IS bemg made on property I own which 18 not mtended {or sale, lease or rent . A) Owners slgna~ ~L ~'\;.- '\ (j/V/ InspectIon Request 726-3769 C Temporary ServIces or Feeders $ 50 00 $ 69 00 $10000 $ 43 00 $ 300 E : l\fIscellaneous (ServIce/feeder not mcluded) -Each InstallatIOn Pump or lITlgatlOn $ 50 00 Slgn/Outlme Llghtmg $ 50 00 LImIted EnergylResldentIal $ 25 00 Lumted Energy/Commerclal $ 45 00 MInimum ElectrIC PermIt InspectIOn Fee IS $45 00 + Surcharges 4 SUBTOTAL OF ABOVE b > 8% State Surcharge ? 'i 10% Admlmstratlve Fee b'SQ 5% Technology Fee :i 'r TOTAL 774~ Shared Dnve(T )/BUlldmg Forms/Electncal Penmt Applicatlon 8.06 doc _GP___ ~ WIi:. Status Iss u ed 225 FIfth Street, SprIngfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 InspectIOn Lme CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO ISSUED. APPLIED. EXPIRES: VALUE: COM2006-01292 10/10/2006 10/10/2006 04/10/2007 SITE ADDRESS 2725 CENTENNIAL BLVD ASSESSOR'S PARCEL NO 1703254401900 Spllngfield TYPE OF WORK ElectrIcal Work Only TYPE OF USE RepaIr ResIdential PROJECT DESCRIPTION Upgrade to 200 amp servIce Owner JACK ANDERSON Address 915 SHERWOOD PL EUGENE OR 97401 Contractor Type ElectrIcal Contractor OWNER #ofUOIts PrImary Occupancy Group Secondary Occupancy Group PrImary ConstructIOn Type Secondary ConstructIOn Type # of Bedrooms Frontyard Setback SIde 1 Setback Side 2 Setback Rearyard Setback Solar Setbacks Street Improvements Storm 50ewer Avaddble SpecIal InstructIOn Notes DeSCrIptIOn Tvpe of Construction Phone Number 541-484-6201 I CONTRACTOR INFORMATION I LIcense ExpIratIOn Date Phone R-3 I"J~ ..~ I BUILDING INI!QRI\tA'fAll>NI . /Votlfll I U'6E a Uregor/f # of StorlfDA Cation C dOPtea b a1tIit1~I11~ HeIght !lWr;uft~-ooenter 117 :JI t~&I).!.f'jitrsof} to Type of Hda'i' YOUi'll 1'0010(,osei'1lfdrFlJJtllit Water m~"mg the ay Obtam 'hrou "li"i\;~r~ y Range ~lfPber for t center (rv.COPle~8 ~~.tl~Wport Energy Path Ce he Ore Ote th~'l.if/7e~ 1 SprIukled BU1ldlU~!erls 1'8W/,~,,~t1"tlj~~~lIbh:lf.J I DEVELOPMENT INFORMATION I ""<344), ..v<trlO~ REQUIRED PARKING VN NOtlw Dlst THfbS!k,t~ Trees Rqd AU;t;.RfrRtytl" Rqd COMZOIfItt}J t:offY!e EXPIRE A All'. tNr.t:" ,1 !R 'iSH IF r/J:: ~ I PUBLft? ~'fflf):W:MA!I1~t'ERMIT IS YUR/( '\, uu' ONE/gJfOrr~O[l;pe Downspouts/DI ams Total Hdndlcapped Compact I ValuatIOn DescrmtlOn I $ Per Sq Ft or multIplIer Square Footage or BId Amount Value Date Calculated Page 1 of 2 Status Iss u ed CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO' COM2006-01292 ISSUED. 10/10/2006 APPLIED. 10/10/2006 EXPIRES. 04/10/2007 VALUE' 225 Fifth Street, Sprmgfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 InspectIOn Lme Total Valuc of Project "~es ~91d I Fee DescrIptIOn + 10% Admmlstrallve Fee + 5% Technology Fee + 8% State Surcharge Perm ServlFdr 200 amps or less Amount Paid Date Paid Receipt Number $630 $315 $504 $63 00 10/10/06 10/10/06 10/10/06 10/10/06 1200600000000001509 1200600000000001509 1200600000000001509 1200600000000001509 Total Amount Paid $77 49 I, Plan RevIews I To Request an mspectlon call the 24 hour recording at 726-3769. All mspectlOn requested before 7:00 a.m. wIll be made the same workmg day, mspectlons requested after 7:00 a.m. will be made the followmg work day. I Replllred Insnect,IO~~ I ElectrIc Service Approval I eqUlred prIor to ullhty company energIZIng service By signature, I state and agree, that I have carefully exammed the completed apphcatlOn and do herehy cerllfy that all mformahon hereon IS true and correct, dud I further eel tlfy that any and all work pertormed shall be done 10 aU..ordance WIth the Ordmances 01 the City 01 SprIngfield and the Laws of the State of 01 egon pertammg to the work desCrIbed he. em, and that NO OCCUPANCY Will be made of any structure wIlhout pel mISSIOn of the Commumty Services DIVISIOn, BUlldmg Safety I further cerllfy that only contractors and employees who are m comphance With ORS 701 005 wIll be used on thiS project I further agree to ensure that all required mspectlOns are requested at the proper time, that each address IS readable from the street, that the permit card IS located at the front of the property, and the approved set of plans wIll remam on the site at all times dun con:;:q V' Sl 1 U _ I () _ cJ b Owner 0 Contra or~ Slgna~uie ~ I Date Paee 2 of2 - Construction Contractors Board 700 Summer St NE SUIte 300 PO Box 14140 Salem OR 97309-5052 Phone. 503-378-4621 Web Address' www ccb state.or us Penrut # Co vV'\'Z-o-.i\,_ 0 IZ '1 Z- Address Z 7Z S- ~ ~'^ ,.4- ( Dd Date /6/r /0 b Issued by Statement: Information Notice to Property Owners About Construction Responsibilities Note Oregon Law, ORS 701 055(4) requires residential constructIOn permit applicants who are not licensed with the ConstructIOn Contractors Board to sign the following statement before a bUlldmg permit can be Issued This statement IS reqUired for residential bUilding, electrical, mechamcal and plumbing permits Licensed architect and engmeer applicants, exempt from licenSing under ORS 701 01O(7), need not submit this statement This statement will befiled with the permit Fill m the appropnate blanks and ImtIal boxes I and 2, and either box 3A or 3B ~l ~ I own, reside m, or will reside m the completed structure I understand that I must become lIcensed as a constructIOn contractor If the structure IS sold or offered for sale before or on completIOn o 3A My general contractor IS (Name) (CCB #) I Will mstruct my general contractor that all subcontractors who work on the structure must be lIcensed With the ConstructIon Contractors Board OR ~3B I Will be my own general contractor If! lure subcontractors, I Will hire only subcontractors lIcensed With the ConstructIon Contractors Board If! change my mmd and hire a general contractor, I Will contract With a contractor who IS licensed With the CCB and wIllllnmedlately notIfY the office IssUIng thiS bUlldmg permit of the name of the contractor I hereby certify tbat tbe above mformatlOn is correct and tbat I bave read and do understand tbe Information Notice to Prope Owners abo t Consta::uctlOn ResponSibilities on tbe reverse Side of tbis form IO-jO-Ob (Date) Ite copy to ISsuing agency permit file, pmk copy to applicant) Property_owner doc 06-01-04 \Acti~~ ~~:~~~~r_Own General C~~tractor? INFORMATldN NOTICE'TO PROPERTY OWNERS ABOUT CONSTRUCTION RESPONSIBiliTIES , - NOTE This Information Notice to Property Owners about Construction Responsibilities was developed by the Construction Contractors Board In accordance with ORS 701 055(5), passed by the 1989 Oregon Legislature If you are actIng as your own contractor to construct a new home or make a substantial Improvement to an eXlstmg structure, you can prevent many problems by bemg aware of the followmg responSibilities and concerns Employer Responsibilities You Will, m most mstances, be ruled to be an "employer" and the contractors you contract with will be "employees" If you use contractors not licensed With the ConstructIOn Contractors Board to do labor m constructmg or to asSist In the construCTIon or, Improvement of a reSidential structure As the employer, you must comply with the foUowing: Oregon's Withholding Tax Law: As an employer, you must Withhold 'income taxes from employee wages'at the tIme employees are paid You Will be liable for the tax payments even If you don't actually Withhold the tax from your employees For more mformatlon, call the Department of Revenue at 503-378-4988 " Unemployment Insurance Tax: As an employer, you are required to pay a tax for unemployment Insurance purposes~ on the wages of all employees For more Information, call the Oregon Employment Department at 503-947-1488 , -~ The Oregon BUSIness IdentificaTIon Number (BIN) IS a combIned number for both Oregon Wlthholdmg and Unemployment Insurance Tax To file for a BIN, call 503-945-8091 or wwwdor state or us/formsnav htmll for the appropnate forms , Workers' Compensation Insurance' As an employer, you are subject to the Oregon Workers' CompensaTIon Law, and must obtam workers' compensation msurance for your employees If you fail to obtam workers' compensation msurance, you could be subject to penalties and be liable for all claim costs d' one of your employees IS mJured on the Job For more mformatlOn, call the Workers' CompensatIOn DIVISIOn at the Departnlent of Consumer and BUSIness SeTVIces at 503-947-7815 U.S. Internal Revenue Service: As an employer, you must Withhold federal mcome tax from employees' wageS'~ You Will be liable for the tax payment even If you didn't actually Withhold the tax For a Federal EIN number, call the IRS at 1-800-829-4933 or VISIt therr web site at w\\w us <lOV Other Responsibilit~es and Areas of Concerns Code Compliance. As the permit holder for thiS proJect, you are responSible for resolvmg any faIlure to meet code reqUIrements that may be brought to your attenTIon through mspecTIons , " !: LIability and Property Damage Insurance' Contact your msurance agent to see If you have adequate msurance coverage for aCCidents and orrusslons such as falling tools, pamt over spray, water damage from pipe punctures, fire or work that must be redone " TIme: Make sure you have suffiCIent time to supervIse your employees " .., \' ... i - ., ~ Expertise: Make sure you have the skills to act as your own general contractor, to coordmate the work of rough-m and fimsh trades, and to notIfy bUlldmg offiCials as the app.vpuate times so they can perform the reqUired mspectlOns If you have additional quesTIons call the ConstructIOn Contractors Board (503-378-4621) or wnte the agency at PO Box 14140, Salem, OR 97309-5052 ~ 'tJ!.. '1 Property_owner doc 06-01-04 /' ~. C,'- ~f Sprmgfield OfficIal ReceIpt D, .Aopment ServIces Department PublIc Works Department 225 FIfth Street Sprmgfielll', Oregon 97477 541-726-3759 Phone Job/Journal Number COM2006-01292 COM2006-01292 COM2006-0 1292 COM2006-01292 Payments Type of Payment Cash Change Job/Journal Number COM2006-01292 COM2006-01292 COM2006-0 1292 COM2006-0 1292 Payments Type of Payment Cash Change cReCClOl] RECEIPT #, 1200600000000001509 Date' 10/10/2006 DescnptlOn Perm Serv/Fdr 200 amps or less + 5% Technology Fee + 8% State Surcharge + 10% AdmInistrative Fee PaId By JACK ANDERSON JACK ANDERSON Item Total Check Number AuthOrization Received By Batch Number Number How ReceIVed dJb In Person dJb In Person Payment Total DeSCription Perm Serv/Fdr 200 amps or less + 5% Technology Fee + 8% State Surcharge + 10% AdmInistratIve Fee PaId By JACK ANDERSON JACK ANDERSON Item Tatar CheCk Number AuthOrizatIOn Received By Batch Number Number How Received dJb In Person dJb In Person Payment Total Page I of I 113756AM Amount Due 6300 3 15 504 630 $77 49 Amount Paid $80 00 ($251) $77 49 Amount Due 6300 3 IS 504 630 $77 49 Amount Paid $80 00 ($251) $77 49 10/1 0/2006